- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.84 / $544.99 / $711.00
| Professional | | $432.84 | $544.99 | $711.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.78 / $606.77 / $1,184.76
| Professional | | $402.78 | $606.77 | $1,184.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.08 / $719.52 / $1,504.13
| Professional | | $521.08 | $719.52 | $1,504.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.63 / $625.05 / $789.84
| Professional | | $517.63 | $625.05 | $789.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.16 / $543.36 / $1,025.47
| Professional | | $351.16 | $543.36 | $1,025.47 |